Association of surgical strategy guided by Wu’s classification with surgical outcomes in left-sided hepatocellular carcinoma patients with frailty

Frailty often indicates a poor prognosis after hepatectomy. This study aims to compare the short-term and long-term prognostic impacts of the Wu’s classification group and the traditional group in treating left-sided hepatocellular carcinoma patients with frailty. This retrospective cohort study analyzed 258 patients with left-sided hepatocellular carcinoma with frailty from 2009 to 2021, who were divided into a Wu’s classification group and a traditional group based on surgical approach. Propensity score matching (PSM, 1:1) was used to minimize baseline differences and reduce selection bias. Perioperative outcomes, overall survival (OS), and recurrence-free survival (RFS) were evaluated. Kaplan–Meier survival analysis was performed to compare OS and RFS between the two groups, and Cox regression models were applied to identify independent prognostic factors. A total of 258 patients were included in the analysis cohort. Among them, 104 patients were assigned to the Wu’s classification group, and 154 patients to the traditional group. After PSM, 186 patients were matched, with 93 patients in each group. The Wu’s classification group demonstrated significantly lower intraoperative blood loss ( P < 0.001), blood transfusion rate ( P = 0.018), incidence of Clavien-Dindo grade ≥ 3 complications ( P = 0.014), postoperative hospital stay ( P < 0.001), and hospitalization costs ( P = 0.035) compared with the traditional group. No significant difference in RFS was observed between the two groups, while the Wu’s classification group demonstrated significantly higher OS ( P = 0.004). Hospital frailty risk score (HR = 1.672, 95% CI 1.498–1.866, P < 0.001) were independent risk factors for OS. Wu’s classification-guided surgical strategy is associated with anatomical resection, less invasiveness, fewer postoperative complications, lower medical costs, and longer long-term survival among frail patients with left-sided HCC.